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Mental Health and Addiction Ad Hoc Agenda 10/08/2019Mental Health and Addiction Ad Hoc Committee Workshop October 8, 2019 – 8:30 am – 12:30 pm Collier County Museum – Main Campus 3331 Tamiami Trail E. Naples, FL 34112 1.Call to Order 2.Pledge of Allegiance 3.Roll Call 4.Adoption of the Agenda 5.Public Comment 6.Adoption of Minutes from the September 27th Meeting 7.Staff Reports 7.1. Review of Remaining MHAAHC Dates and Workshop 7.2. Introduction of Mark Englehardt 8.New Business 8.1. Draft Committee Report Review 8.2. Existing Committees and Future Recommendations (Sean Callahan) 9.Old Business 10.Public Comment 11.Announcements 12.Committee Member Discussion 13.Next Meeting Time, Date and Location 12.1. October 22, 2019 – 8:30 am – 10:00 am – Collier County Museum 14.Adjournment 11.3.b Packet Pg. 444 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 1 | P a g e MINUTES OF THE REGULAR MEETING OF THE COLLIER COUNTY Mental Health and Addiction Ad Hoc Committee Meeting September 24, 2019 Naples, Florida LET IT BE REMEMBERED that the Collier County Mental Health and Addiction Ad Hoc Committee met on this date at 8:30 A.M. at 3331 Tamiami Trail East, Main Campus Museum, Naples, Florida with the following Members Present: Mental Health Committee Present: Not Present: Lt. Leslie Weidenhammer Scott Burgess Council Member Michelle McLeod Pat Barton Trista Meister Janice Rosen Dr. Paul Simeone Caroline Brennan Dr. Jerry Godshaw (Phone) Dr. Michael D’Amico Michael Overway Dr. Thomas Lansen (Phone) The Honorable Janeice Martin Dr. Pam Baker Susan Kimper (Phone) Russell Budd (Phone) Reed Saunders (Phone) Dale Mullin Also Present: Sean Callahan – Executive Director-Corporate Business Operations Heather Cartwright-Yilmaz – Sr. Operations Analyst Katina Bousa, Director, Inmate Services, Collier County Jail 1.Call to Order & Pledge of Allegiance Chairman Scott Burgess called the meeting to order at 8:38 A.M. and led the Pledge of Allegiance. 11.3.b Packet Pg. 445 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 2 | P a g e 3.Roll Call – Committee Members Seventeen (17) members of the Mental Health and Addiction Ad Hoc Committee were present, representing a quorum. 4.Adoption of the Agenda A motion was made for the adoption of the agenda and it was approved. 5.Public Comment There was no public comment. 6.Adoption of Minutes from Previous Meeting A motion was made and amended minutes from the previous meeting were approved. 7.Staff Reports 7.1 Review of Remaining MHAAHC Dates and Workshop Committee discussion ensued around remaining schedule. The October 8th meeting will be a longer session as a page by page project review. The October 22nd meeting will be for preparation and rehearsal. Discussion then ensued around the Adhoc Committee sunset and Workshop on October 29th. 8.New Business 8.1 Draft Committee Report (Chet Bell – not included in agenda packet) Chairman Burgess introduced Chet Bell. Mr. Bell and Mr. Englehart plan to be at the October 22nd meeting. Committee discussion ensued around the formal name of the Committee with the correct use being consistent throughout the document – “The Collier County Mental Illness and Addiction Ad Hoc Advisory Committee.” The Committee agreed that the wording should match the resolution. The Committee agreed a PowerPoint presentation document be created that has powerful graphics with pictures. The PowerPoint will include a picture of the Committee at work with the plan. It was recommended the PowerPoint presentation be the presentation instrument during the Workshop that will include the full report. The Report/White Paper will include bullet points rather than narrative with clear and concise message throughout to include graphs, charts and infographics for added interest. Mr. Bell lead discussion about introductory section 11.3.b Packet Pg. 446 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 3 | P a g e to include Committee members and its charge with acknowledgement for services. The appendix will have introductory section with an acknowledgement for the Community Foundation, funding and services. Mission Statement: Discussion ensued around the mission statement. “The Committee will collaboratively plan and support a coordinated effort for a full array of evidence informed services and support to improve the lives of individuals with mental health and substance abuse disorders and overall quality of life in Collier County.” PP 2 last paragraph: Without losing fundamental meaning, simplify points. Mr. Bell will bullet this area. PP 3 2nd paragraph. Recommended bullet points or sub headers under priorities. Mr. Bell will review section to ensure that not repetitive. Last year’s plan in appendix, can be distilled to a summary. Sustainability and depth to be trimmed down to 2-3 key words with broad overview from last year’s plan with rank order. PP 3 3rd paragraph: In its plan SAMHSA identified 5 priorities. The agency that seeks funding from the state. The simplicity of language with referencing. Reference same approach. When we reference number include written number. Recommended language: In its investigation the Committee considered models from agency that allocates funding. Mr. Bell will do some work with this. Last paragraph pp 3 and 1st PP4: Confirmed recommendations and ranking on priorities. Last paragraph on pp 4: Mission Statement and List of priorities being bolded. Do a sub header here: bolding, headers or callouts. Public must be able to read in 5 minutes or less. Special Consideration: Bold Veteran, bold Veteran Services, Seniors and Special Needs (evidence-based practices) to draw components in there. This report identifies…needs to be bolded or stand out for public take home on this. Discussion ensued around Veterans and Seniors with unique needs and unique resources. Use different language for special considerations for evidence based. Recognized that Committee seen veterans as unique and recommended to include a paragraph. Must craft language to apply to the unique needs and unique resources for Veterans and Seniors. Mr. Bell updated the paragraph for evidence-based practices, seniors and veterans. The following recommendation was made: “Special attention must be paid to the unique needs of our veterans’ population and all activities related to these priorities. The Committee also received input from the public regarding special needs population of seniors.” The Committee ensued discussion around creating a 3rd special considerations for evidence- based practices, seniors and veterans. Add adult to the mission statement and remove individuals. To improve the lives of adults with substance abuse issues. Use language in resolution. 11.3.b Packet Pg. 447 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 4 | P a g e PP5: Throughout priorities there is some inconsistency. Include: Priority statement, overview, objective, outcome, impact and data element to effect outcome and impact... Priority 1: Best example of what we want and how we want them to read. Please take this in mind as we review them. The discussion ensued around the priority and overview. Priority 1: Central Receiving Facility: Do we want to continue the Priority Statement? Ensure that all have components identify why, needs, problems with remedy. Put as many bullet points with statistics. PP 5 paragraph 2 Overview: The Marchman act is either treated at the jail or at the NCH and neither facility is built…. Susan Kimper will send data that want to have included to integrate into the plan. The need had already been established and will be included in the appendix. We want this to be very concise and action oriented. The previous work needs to be included in appendix with a paragraph. Include stats in the appendix as we did previously. Remember that we are also recommending data collaborative. Update data in earlier report to be included. Provide data that supports these priorities. This information will also be included in the PowerPoint. The document that was written last year will be included as addendum with current data with appendix. Additional Items: 1. Update data in earlier report 2. Ensure that Presentations made on the 29th, provide data that support priority that we use in PowerPoint presentations. Priority 1: Infrastructure Surtax Citizen Oversight Committee…will give good scrub. The Committee recommended realistic timeframe for the Central Receiving Facility to be completed and services be operating by end of 2022. 4th Paragraph: Too much language. Recommending simplifying to: “The legislature funded awards for central receiving systems to three Florida communities as part of pilot.” Committee discussion ensued around extending the October 8th meeting. Mr. Bell and Mr. Englehart will likely be in Collier County for the October 8th meeting from 8:30-12:00. Committee: Look at specific areas, wordsmith, break things out, bullet points, add data, come prepared. Consider PowerPoint language for specific areas. Mr. Bell will summarize and will incorporate into document. Mr. Englehart will take the lead and massage the document. The way you want to modify document. Get the changes to Sean and he will get the information to Mr. Bell and Mr. Englehart. Continue to provide feedback. 11.3.b Packet Pg. 448 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 5 | P a g e Get changes/updates to Sean by Monday, October 30th. Sean will add feedback and note it as such to Mr. Bell and Mr. Englehart. Separate document and will be added into document. Judge Janeice Martin will help with wordsmithing and other items as needed. Discussion ensued around Priority 2: The work product had the correct information. Committee discussion ensued around the Overview describes the need and eliminate the Priority Statement. Make sure that overview has the right information. 8.2 Existing Committee and Future Recommendations (Sean Callahan) The Committee reviewed the list provided by Sean. The BCC will approve/deny plan during Board meeting in November/December. In early 2020, integrate the plan into another Committee. Establish oversight committee as continued effort and coordination for plan. Chamber or Community foundation may be great mechanism for completion. Having collaboration with key areas that community identified as major priorities: Mental Health, Senior Services, Affordable Housing. Major issues that public is not aware of various issues. Recognize that community does not know and reinforce message for consistencies. Review priorities give recommendations on a quarterly basis. Continue to have meetings with county staff to ensure that plan is met for oversight to ensure plan is completed. 9.Old Business There was no business on the agenda besides the workshop agenda. 10.Public Comment Mike: Service Members and Families for Veterans Council. Was invited by Dr. Baker. Reviewed special considerations. The Veterans suicide, PTSD will not be able to drive 3 of the critical points. Objectives, reduced veterans’ suicide, note that data not available for CC. Recommended that coroner note and report to CDC and VA on Veteran Suicide. When data is reviewed for homeless, do not expect that homeless will come to you. Must go to them. Start support group for Veterans only November 7th with NAMI. Florida lost 512 to suicide since 2017. Florida is number one state for veteran suicide and will send report to Dr. Baker. He sits on Lee County called Community Health Improvement Plan. CHIP The speaker suggested that other important minority groups were left off, including LGBTQ, elderly, veterans that are 55 above. He also recommended special consideration be granted to help identify and help the families. Care givers for veterans are now large group that commit suicide. Will get report to Dr. Baker for Sean Callahan to share with Committee. 11.Announcements The Committee agreed to have group picture taken on October 8th. Heather Cartwright- Yilmaz set that up. 11.3.b Packet Pg. 449 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 6 | P a g e 12. Committee Member Discussion There was no further discussion. 13. Next Meeting Time, Date and Location October 8, 2019 – 8:30-12:00 pm – Collier County Main Museum 14. Adjournment The meeting adjourned at 10:20 am with nothing further left to discuss. Collier County Mental Health and Addictions Ad Hoc Advisory Committee Scott Burgess – Chairman The foregoing Minutes were approved by Committee Chair on October 8, 2019, “as submitted” [ ] or “as amended” [ ] 11.3.b Packet Pg. 450 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 1 Collier County Mental Illness and Addiction Ad Hoc Advisory Committee Report to the Collier County Commission Mental Health and Addiction Services 5 Year Strategic Plan 2020-2024 Add picture of the committee at work in introduction A few infographics for each priority – i.e. Baker Acts annually Need for powerpoint presentation for submission to County Submitted October 29, 2019 Formatted: Highlight 11.3.b Packet Pg. 451 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 2 Committee Origin, Membership, and Charge On December 11, 2018 the Collier County Board of County Commissioners approved Resolution 2018-232 establishing the Mental Illness and Addiction Ad Hoc Advisory Committee. The Advisory Committee was charged to make recommendations regarding the County’s role in providing assistance and treatment of adults with mental health and substance use disorders. The Resolution required that Committee membership not exceed 19 individuals appointed by the Board with consideration given to ensure geographic and background diversity. Special qualifications for membership included: • representative designated by a Veteran services organization; • representative designated by the Collier County Sheriff’s Office; • representative designated by a Collier County grantor entity which provides funding to providers of services for mental illness and substance abuse use disorders for adults; • psychiatrist, licensed to practice in Florida; • behavioral health professional, licensed to practice in Florida; • medical health professional; • representative from a homelessness advocacy organization; • representative of the David Lawrence Center, Inc.; • representative from the National Alliance on Mental Illness; • a certified peer specialist; • representative from the recovery community; • representatives from the local business community; and, • representatives at-large with experience or demonstrated interest in mental illness and substance use disorders. The Resolution defined the purpose of the Committee to include “providing input from all entities involved in providing assistance to, and the treatment of, persons with mental health or addiction issues, both public and private, as well as members of the public, to identify existing mental and behavioral health services issues in the community to ensure the inclusion of all possible services, treatment, and public and p rivate assistance for county residents struggling with mental illness and/or substance abuse disorders.” The Committee would like to acknowledge the support of the Community Foundation of Collier County for their generous financial support to hire outside consulting services in support of completion of this plan. Formatted: Not Highlight 11.3.b Packet Pg. 452 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 3 Mission Statement The Committee adopted the following mission statement: “The Committee will collaboratively plan for and support a coordinated effort for a full array of evidence informed services and supports to improve the lives of adults with mental health and substance use disorders and overall quality of life in the Collier County community.” Collier County Committee Work and Report Development The Mental Illness and Addiction Ad Hoc Advisory Committee was organized and convened for the first time on January 4, 2019. Ultimately the Committee met 21 times over the course of the year, including 18 regular meetings and 3 half day workshops to organize the information included in this report. The Committee utilized its meeting time to gather information and develop strategies to implement the priorities established in the Mental Illness and Substance Abuse Strategic Plan submitted to the Board of County Commissioners in June 2018 and included as an appendix to this report. External subject matter experts made presentations to the Committee on issues related to Housing, Veteran Services and the design of a Data Collaborative. The knowledge gained from study of those priorities was applied in 4-hour planning workshops held on August 10, September 12 and October 8. During these workshops the Committee restated those priorities and established the goals, objectives and a logic model for the implementation of each priority that follow in this report. In preparing this report the Committee used the format employed by the Substance Abuse and Mental Health Services Administration (SAMHSA) in its most recent Strategic Plan. SAMHSA is the federal agency that promotes a vision for the United States behavioral health care system, establishes national policy directives along with other Federal partners and allocates Mental Health and Substance Abuse funding to states and local communities through block and discretionary grant programs. In the the spirit of Recovery, the Committee recognizes SAMHSA’s working definition of recovery from mental disorders and/or substance us disorders that was developed by dozens of stakeholders as: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential”. There are four major dimensions that support a life in recovery: Health, Home, Purpose and Community. With those four pillars, there are 10 Guiding Principles of Recovery: 1. Recovery emerges from hope Formatted: Not Highlight 11.3.b Packet Pg. 453 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 4 2. Recovery is person-driven 3. Recovery occurs via many pathways 4. Recovery is holistic 5. Recovery is supported by peers and allies 6. Recovery is supported through relationship and social networks 7. Recovery is culturally-based and influenced 8. Recovery is supported by addressing trauma 1. Recovery involves individual, family and community strengths and responsibility 9. 2. Recovery is based on respect 10. . This report attempts to replicates SAMHSA’s approach, then summarizes our recommendations for each priority through the use of a logic model. This report identifies six (6) priorities that we recommend receive ongoing attention and support by the Board of County Commissioners over the next five years. Some priorities will require substantial financial support, while others will require little funding, but will require the involvement of County staff working in collaboration with community partners. The priorities, ranked in order of their relative importance by the Committee, are: 1. Build and Operate a Central Receiving Facility/System to Serve Persons Experiencing an Acute Mental Health or Substance Use Crisis 2. Increase Housing and Supportive Services for Persons with Serious Mental Illness and/or Substance Dependence 3. Establish a Mental Health and Substance Use Disorder Data Collaborative for Data Sharing, Collection and Outcomes Reporting 4. Increase the Capacity and Effectiveness of Justice System Response for Persons Experiencing Serious Mental Illness and/or Substance Use Disorders 5. Revise and Implement Non-Emergency Baker Act and Marchman Act Transportation Plans 6. Improve Community Prevention and Advocacy Related to Mental Health and Substance Use Disorders Bold Mission, Bold Priorities, Bold veterans and Evidence Based Practices Special Considerations Formatted: Font: (Default) Arial, 12 pt Formatted: Font: (Default) Arial, 12 pt Formatted: No Spacing, Left, Indent: Left: 0.5" 11.3.b Packet Pg. 454 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 5 The Committee identified two populations that we recommend receive special consideration in all actions related to these priorities. Specific attention must be paid to the unique needs of Veterans in all activities related to these priorities, ensuring that there is easy access to treatment and specialized programs to assist Veterans experiencing Post Traumatic Stress Disorder and Traumatic Brain Injury both in community programs and from the Veteran’s Administration. The Committee also received input from the public regarding the special needs of Senior Adults, particularly those in cognitive decline who experience profound changes in their behavior and emotional stability as a result of their illness. These individuals require specialized care very different from that provided in Baker Act Receiving Facilities that primarily treat individuals in crisis from a mood or thought disorder. In addition, all services, programs and activities related to the identified Priorities and special populations must be grounded in the best available Evidence Based or Evidence Informed Practices in order to ensure maximum quality and cost effectiveness in services provided to the community. On the following pages find the Committee’s recommendations regarding our Priorities, including Goals, Objectives and Outcomes anticipated for each. Logic models for each Priority are also provided, offering an “at a glance” overview of the inputs required, activities to be conducted and outcomes anticipated for each Priority. 11.3.b Packet Pg. 455 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 6 Priority #1 Build and Operate a Central Receiving Facility/System to Serve Persons Experiencing an Acute Mental Health or Substance Use Crisis Overview: A central receiving system consists of a designated central receiving facility and other services providers that serve as a single point or a coordinated system of entry and treatment for individuals needing evaluation or stabilization under section 394.463 (Baker Act) or section 397.675, (Marchman Act) Florida Statutes, or crisis services as defined in subsections 394.67(17)-(18), Florida Statutes. It should be noted that currently there is no provision for involuntary evaluation or stabilization under the Marchman Act unless a secure Addictions Receiving Facility is funded. Due to this service deficiency all persons requiring such services are treated at the Collier County Jail, a facility neither designed nor appropriate for that purpose. The Collier County Community Needs and Assets Assessment (2017) noted the need for additional inpatient beds and more than 80% of its health focus group participants identified mental health and substance use issues as major public health problems The Collier County Municipal Infrastructure One-Cent Sales Surtax will provide $25 million to build a new facility that will house these services and increase capacity. While the Surtax will provide the infrastructure necessary to expand capacity, additional funds will be required to provide the human resources and other ongoing operational costs associated with the central receiving system. Funding to support operations, estimated to $2 Million and $3 Million annually, will require both state and county funding. In 2016-2017 the Florida Legislature authorized the Department of Children and Families to support central receiving systems and awarded funding to 3 Florida communities. A Legislative Budget Request closely aligned with the requirements of the FY 16-17 appropriation and support with matching dollars from Collier County appears to be a logical approach for obtaining the needed operational funds. Goal: Ensure that there is a coordinated system and adequate capacity to assure that citizens in crisis will be able to access emergency mental health and substance use disorder services over the next 20 years. Objectives: 11.3.b Packet Pg. 456 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 7 •Design, build, staff and operate Central Receiving Facility/System including an access center and follow up recovery-oriented treatment services in the community Services by 2022 •Assure sustainable funding to ensure ongoing Central Receiving operations over the next 20 years. •Provide both Co-occurring Baker Act (Crisis Stabilization) and Marchman Act (Detoxification) services as part of Central Receiving Facility/SystemServices. •Explore the feasibility of providing primary integrated healthcare at the new facility Outcome/Impacts: •Increased access to mental health and substance use disorder crisis care •Improved crisis care by offering a full range of mental health and substance use crisis services and by providing direct linkage and a warm hand off to community- based services following crisis care •Reduced law enforcement processing time for an immediate drop off •Provide appropriate jail diversion options and services •Reduced transfer time from local hospitals •Improved patient satisfaction with access to and quality of care in crisis services. Data elements required to assess outcome and impact: •Episode of care data; •Baker Act and Marchman Act Data – Both public and private facility data from residents and non-residents of Collier County •Law enforcement time in drop off data; •Hospital transfer referral data; •Crisis Intervention Team (CIT) data •Jail Diversions as a result of the Central Receiving System •ClientPatient satisfaction questionnaire at discharge Workgroup: Scott Burgess, Susan Kimper 11.3.b Packet Pg. 457 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 8 Priority #2 Increase Housing and SupporiveSupportive SerivesServicest for Persons with Serious Mental Illness and/or Substance Dependence Overview: For people with mental health and substance use disorders, housing is considered a ‘golden thread’, providing the foundation through which all aspects of treatment and recovery are possible. When this basic need isn’t met, people cycle tragically in and out of homelessness, jails, shelters, and hospitals at a high cost to individuals and society. The Urban Land Institute’s 2017 report on housing, land use and real estate issues in Collier noted that an area of concern was the lack of residential mental health care and support services. Further, the recent Collier County Needs Assessment Survey identified Housing as the number one community need in th e county. While this need extends beyond those with severe mental illness or substance dependence, the housing shortage exacerbates the problem for these especially vulnerable individuals. Due to low incomes (typically less than $800 per month), discrimination, and difficulties in daily functioning, persons with serious mental illnesses and substance use disorders generally cannot compete for market rental housing. Additionally, affordable housing units and supported housing programs have long wait lists and few in need can access them when in need. To be successful, housing supports should follow evidence-based and evidence- informed practices, including the use of the SAMHSA Permanent Supportive Housing Tool Kit ; a ‘Housing First’ philosophy and model in which housing is a right, not a privilege; eligibility is not dependent on psychiatric treatment compliance and sobriety; and housing units are integrated within the community. An array of options should include rental assistance vouchers, rapid re-housing, recovery housing, transitional housing, peer run respite, and permanent supportive housing, each bundled with appropriate levels and choices of services and supports. Goal 1: Increase availability and accessibility of a variety of housing options and supportive services for persons with mental health and substance use disorders. Objectives: •100% of all Collier County approved affordable housing will include the required 10% set aside for persons with a dedicated portion for mental health Formatted: Not Highlight Formatted: Not Highlight 11.3.b Packet Pg. 458 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 9 and/or substance use disorder, which may require Board of County Commissioners action. •Increase number of private landlords accepting rental assistance vouchers. •Increase number of supportiveed housing and supported employment provider agencies. •Increase individual incomes beyond disability amounts to ensure long term stability. •Ensure supported housing rents are limited to 30% of the individual’s income. •Implementation of a high fidelity Permanent Supportive Housing Evidenced- based program Goal 2: Homelessness among persons with mental health and substance use disorders is rare, brief and one-time. Objectives: •100% of chronically homeless who are diagnosed with a severe mental health disorder will be housed within x days of enrollment in coordinated entry. •100% homeless individual will have immediate access to low-barrier emergency shelter •100% of persons with a serious mental health disorders identified annually during the Point in Time count will not meet the definition of chronically homeless. •Increase number of SOAR (SSI/SSDI Outreach, Access and Recovery)- trained staff and # dedicated staff hours to facilitate attainment of Social Security benefits for eligible individuals. Outcomes/Impact: •Increased nNumber of affordable housing units available to persons with a mental health and/or substance use disorder. •Increased nNumber of persons receiving rental assistance/low income housing/housing voucher •Increased nNumber of persons attaining SSI/SSD and accompanying Medicaid or Medicare benefits Formatted: Not Highlight 11.3.b Packet Pg. 459 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 10 •Increased nNumber of peerof peer specialists employed in variety of roles in mental health and substance use programs •Increased number Number of days that housing residents are stably housed in the community •Increased number Number of days that housing residents worked for pay Data elements required to assess outcome and impact: •Number of agencies/providers; •Increased capacity/number of available housing units; •Number of hours of supportive services provided; •Number of persons or months on housing wait lists; •Number of persons who are chronically homelessness identified during annual Point in Time count; •County annual housing report, •State SAMH data system; •Drug Court Case management system; •Number of people accessing supportive housing upon reentry from county jail and mental health or veterans treatment court •Local data collaborative reports. •Cost effectives report on permanent supportive housing after implementation •Qualitative analysis from the residents served in supportive housing services; individual and focus group methods Workgroup: Dr. Pam Baker, Cormac Giblin, Dr. Jerry Godshaw, Michael Overbay 11.3.b Packet Pg. 460 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 11 Priority #3 Establish a Mental Health and Substance Use Disorder Data Collaborative for Data Sharing, Collection and Outcomes Reporting Overview Chapter 163.62 F.S authorizes governmental and certain private agencies to share information. The mission of a mental health and substance use disorder data collaborative would be enhancing the delivery of mental health programs to Collier County residents by encouraging communication and collaboration among all related community providers, organizations, interested government agencies, and educational institutions. Potential partners would include , among others, the Collier County Board of County Commissioners, Clerk of Circuit Court, Collier County Sheriff Office, the XXXX Judicial Circuit Court of Florida, Central Florida Behavioral Health Network, David Lawrence Center, Collier County Schools, Florida Department of Juvenile Justice, and the he Louis de la Parte Florida Mental Health Institute (FMHI), a part of the University of South Florida (USF) Department of Mental Health , Law and Policy (Louis de la Parte Florida Mental Health Institute), would be the primary members of the collaborative. Goal: Create a data collaborative that will collect and analyze data from all stakeholders that provide services to persons experiencing a mental health and/or substance use disorder and use that information to continuous improve program quality and patient outcomes. Objectives: •To inform the planning and delivery of mental health and substance use prevention and treatment among all related community organizations. Multiple sources will collect internal data and share with other entities, providing a process for comprehensively using relevant data, both at the system and clinical levels, •Collect aAggregate data for use in planning, quality improvement, program evaluation, and grant applications. A repository, along with staff, is required to maintain, aggregate, and disseminate reporting on the data collected. Outcomes/Data: A centralized data collaborative could collect information from entities including the David Lawrence Center, National Alliance on Mental Illness, hospitals, courts, law enforcement, community providers, including but not limited to: Formatted: Centered, Space After: 0 pt Formatted: Not Highlight 11.3.b Packet Pg. 461 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 12 •Numbers and demographics of persons served by each cross-system and provider •Calculation of the cost or persons served by each payer system, DCF, Medicaid, County Jail, Medicare/Medicaid, Department of Corrections, housing etc. provider •Demonstration of cost avoidance in criminal justice involvement through jail diversion and reentry activities •Justification for efficient distribution of public funding •Number of days acute care units are at or over capacity •Other metrics used to gauge effectiveness and efficiencies of the community health system Action Items: •Start with a list of data points we would like to report on – including frequency, length of treatment, outcomes, granularity, and sophistication of data efforts can be leveraged from those employed in other communities; •Consult with the USF Department of Mental Health, Law and Policy about existing data collaboratives and permissions necessary to access public dataWork backward to outline who was needed to participate in the collaborative and what specific data was necessary; •Draft MOUs for each participating entity surround collection and distribution of data; •Establish a steering committee to guide the project development; •Design a project plan to establish the database to house collaborative data; •Begin to collect data and report on a routine basis. Workgroup: Sean Callahan, Dr. Gerry Godshaw, Michael Overway Formatted: Not Highlight 11.3.b Packet Pg. 462 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 13 Priority #4 Increase the Capacity and Effectiveness of Justice System Response for Persons Experiencing Serious Mental Illness and/or Substance Use Disorders Overview: Persons with mental health disorders and/or substance use disorders are at disproportionate risk to experience involvement with the criminal justice system. Predictably, traditional justice responses such as jail or prison have done little to address what is ultimately a treatable medical problem. Communities have been frustrated by poor outcomes among this population in traditional justice settings, as persons with these disorders have cycled in and out of jails at great expense, with no discernible benefit to the individual or the community. Enter the Problem-Solving Court movement, now an international effort, which began when Miami-Dade County created the first drug court in 1989. The Problem-Solving Court model has evolved to recognize certain key components, and corresponding standards have been developed to ensure that all courts incorporate those components. Simply stated, the model involves a multi-disciplinary team, led by a judge, serving a targeted population within the criminal justice system which has an identifiable and serious need for treatment intervention. The team aims to identify, as early in the process as is possible, those persons in the justice system for whom a program of intensive treatment, supervision and accountability can reasonably be expected to end the justice involvement successfully, restore the individual to wellness and self- sufficiency, and facilitate a lasting recovery from the disorder(s) that contributed to the criminal conduct in the first place. The Supreme Court of Florida has promulgated standards for drug courts, and is preparing to promulgate standards for mental health courts and veteran treatment courts. Additionally, the Supreme Court is working on a certification process for these courts, which will ensure fidelity to the promulgated standards and maximize chances for the best possible outcomes across a variety of populations in the state. Further, the Legislature has created a dedicated and recurring funding source for these courts, which funding is expected to be tied into the upcoming certification process. Now is a time for significant advancement of these powerful courts, and communities are wise to commit themselves to positioning their courts to take advantage of these developments for the best possible service of their population’s needs. Collier County has long been a leader among counties in this regard, and has had a drug court since 1999, a mental health court since 2007, and a veteran treatment court since 2012. 11.3.b Packet Pg. 463 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 14 Significant steps need to be taken in order to ensure the sustainability of these courts, as well as to continue to grow and improve them. In addition to problem solving courts, there are a variety of related and complimentary opportunities for increasing the capacity and effectiveness of the justices system’s response to this population. Persons with mental health and substance use disorders are not only disproportionately represented in the criminal divisions of the justice system, but also in the family, domestic violence and dependency divisions. Expanding behavioral health training for judges and practitioners within each of these divisions will ensure that persons in need of treatment will be assisted in accessing it, and outcomes overall will benefit from this holistic approach. Priority #4 Increase the Capacity and Effectiveness of Justice System Response for Persons Experiencing Serious Mental Illness and/or Substance Use Disorders Overview: Persons with mental health disorders and/or substance use disorders are at disproportionate risk to experience involvement with the criminal justice system. Predictably, traditional justice responses such as jail or prison have done little to address what is ultimately a treatable medical problem. Communities have been frustrated by poor outcomes among this population in traditional justice settings, as persons with these disorders have cycled in and out of jails at great expense, with no discernible benefit to the individual or the community. Enter the Problem-Solving Court movement, now an international effort, which began when Miami-Dade County created the first drug court in 1989. The Problem-Solving Court model has evolved to recognize certain key components, and corresponding standards have been developed to ensure all courts incorporate those components. Simply stated, the model involves a multi-disciplinary team, led by a judge, serving a targeted population within the criminal justice system which has an identifiable and serious need for treatment intervention. The team aims to identify, as early in the process as is possible, those persons in the justice system for whom a program of intensive treatment, supervision and accountability can reasonably be expected to end the justice involvement successfully, restore the individual to wellness and self- sufficiency, and facilitate a lasting recovery from the disorder(s) that contributed to the criminal conduct in the first place. The Supreme Court of Florida has promulgated standards for drug courts, and is preparing to promulgate standards for mental health courts and veteran treatment courts. Additionally, the Supreme Court is working on a certification process for these courts, which will ensure fidelity to the promulgated standards and maximize chances 11.3.b Packet Pg. 464 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 15 for the best possible outcomes across a variety of populations in the state. Further, the Legislature has created a dedicated and recurring funding source for these courts, which funding is expected to be tied into the upcoming certification process. Now is a time for significant advancement of these powerful courts, and communities are wise to commit themselves to positioning their courts to take advantage of these developments for the best possible service of their population’s needs. Collier County has long been a leader among counties in this regard, and has had a drug court since 1999, a mental health court since 2007, and a veteran treatment court since 2012. Significant steps need to be taken in order to ensure the sustainability of these courts, as well as to continue to grow and improve them. In addition to problem solving courts, there are a variety of related and complimentary opportunities for increasing the capacity and effectiveness of the justices system’s response to this population. Collier’s Criminal Justice, Mental Health and Substance Abuse (CJMHSA) Planning Council recently completed an update of its strategic priorities based on the Sequential Intercept Model. Problem solving courts typically are found at Intercept 3. Additional selected priorities and their Intercept points recently identified by the Planning Council include: Intercept 0: Community Services - Central Receiving System operational funding; Supportive Housing, MHIT/Mobile Crisis Unit expansion Intercept 1: Law Enforcement and Emergency Services - Misdemeanor diversion Intercept 2: Initial Detention and Court Hearings - Clinical Assessment and transfer to Central Receiving services when indicated Intercept 3: Jails and Courts - Medication Assisted Treatment for all; In-jail mental health unit Intercept 4: Re-Entry - Warm hand-off to co-located MHSA/Primary Care Unit Intercept 5: Community Corrections - Supportive Probation/Parole/Pre-trial; Medication Assisted Treatment sustainability Maximizing the services provided at each intercept point will maximize the capability of the justice system to utilize its leverage to serve more people and improve their behavioral health outcomes. Goal: Expedite deflection and diversion of persons with mental health and/or substance use disorders prior to arrest and from jail to treatment, thereby reducing recidivism, improving community safety and directing resources to optimize outcomes. Goal: Expand trauma-informed and trauma-responsive practices to all divisions of the justice system, and incorporate the use of court-supervised clinical assessments and treatment plans as appropriate in each division. 11.3.b Packet Pg. 465 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 16 Objectives: • Ensure the sustained commitment of dedicated resources from each of the disciplines represented on the multi-disciplinary teams for each problem-solving court • Ensure the achievement and maintenance of certification status for each problem-solving court, so that stable funding can be obtained and the overall sustainability of these courts can be secured • Ensure the collection and analysis of robust data in connection with the operation of the problem-solving courts so that proper periodic evaluation and adjustment of the courts can be made to optimize efficacy, and so stable funding can be obtained and maintained • Expand capacity of existing problem-solving courts, including the case management services to support persons served by the court in the community • Increase the accuracy and speed with which all incarcerated persons are screened for mental health and substance use disorders • Ensure that incarcerated persons who have been identified as having mental health and substance use disorders are referred to appropriate jail-based or community-based treatment services, as appropriate, and that they are referred promptly to an appropriate jail diversion program or problem-solving court • Expand capacity of jail diversion programs for persons with the most severe and persistent mental health disorders, including the case management services to support persons served by the court in the community • Implement medication assisted treatment in Collier County Jail, and ensure continued access to same in the community upon re-entry, regardless of whether an individual is involved with a problem-solving court or diversionary program. • Increase training for judges, attorneys, probation officers, investigators, case managers, law enforcement officers and all other justice personnel in the causes and treatment of both mental health and substance use disorders, and in topics related to trauma, adverse childhood experiences, and trauma-informed and trauma-responsive practices. • Encourage judges across all divisions to employ trauma-informed practices in addressing parties who come before them, and to ensure that courts are set up to be trauma-responsive whenever possible. Outcomes/Impacts and Data elements required to assess outcome and impact: 11.3.b Packet Pg. 466 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 17 • Reduce number of arrests; • Increase number of incarcerated persons who are screened for mental health and substance use disorders • Identify the number of people with co-occurring mental health and substance use disorders, also in need of primary health care • Conduct an analysis of the number of people served by the court who have health care or are indigent • Improve symptoms; • Improve child and family reunifications with supports; • Reduce time between removal of at-risk or dependent children from parents and reunification of the family unit • Increase number employed; • Increase number receiving additional education and training; • Increased independence and self-reliance; • Maintenance of sobriety - number of days sober; • Reduce relapse rates; • Increase medication adherence rates; • Reduce time between arrest and screening for mental health and substance use disorders; • Reduce time between arrest and referral to an appropriate problem-solving court or diversionary treatment program; • Increased stable housing; • Reduced number of arrests/rearrests; • Increased number of treatment services; • Increased number of appropriate referrals into diversion; • Increased capacity of each diversionary court program; • Increased graduation rates; • Increased pathways to treatment (new programs) • Reduce the number of adverse childhood experiences for children of adults involved in the justice system, and increase opportunities to build resilience for them; 11.3.b Packet Pg. 467 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 18 Workgroup: Judge Janeice Martin, Trista Meister, Janice Rosen, Goal: Expedite deflection and diversion of persons with mental health and/or substance use disorders prior to arrest and from jail to treatment, thereby reducing recidivism, improving community safety and directing resources to optimize outcomes. Objectives: • Expand capacity of existing therapeutic courts, including the case management services to support persons served by the court in the community • Implement medication assisted treatment in Collier County Jail Outcomes/Impacts and Data elements required to assess outcome and impact: Reduce number of arrests; Identify the number of people with co-occurring mental health and substance use disorders, also in need of primary health care • Conduct an analysis of the number of people served by the court who have health care or are indigent • Improve symptoms; • Improve child and family reunifications with supports; • Increase number employed; • Increase number receiving additional education and training; • Increased independence and self-reliance; • Maintenance of sobriety - number of days sober; • Reduce relapse rates; • Increase medication adherence rates; • Reduce time between arrest and connection with treatment; • Increased stable housing; 11.3.b Packet Pg. 468 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 19 • Reduced number of arrests/rearrests; • Increased number of treatment services; • Increased number of appropriate referrals into diversion; • Increased capacity of each diversionary court program; • Increased graduation rates; • Increased pathways to treatment (new programs) Workgroup: Judge Janeice Martin, Trista Meister, Janice Rosen, Formatted: Centered 11.3.b Packet Pg. 469 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 20 PPriority #5 Revise and Implement Non-Emergency Baker Act and Marchman Act Transportation Plans Overview: In the continued best interest of persons in need of public behavioral healthcare in Collier County, there is a need to establish a non-emergency transportation plan for individuals receiving involuntary evaluation and/or treatment under either Chapter 394 or 397 F.S. (Baker Act/Marchman Act) who are transferred between receiving facilities and local hospitals. The plan will ensure the coordination of services among providers in Collier County and provide timely access to care for persons experiencing a mental health/substance abuse crisis. The benefit of a coordinated system of care is less fragmentation of services and a more efficient and cost-effective method of providing transport. The plan would largely eliminate transport by law enforcement, providing a more dignified, humane, and timely method of transportation to and from acute care facilities. The plan also relieves law enforcement of the responsibility to provide transport resulting in additional time available for legitimate law enforcement activities. Hillsborough and Sarasota County have implemented non-emergency transport plans that bills an individual’s private insurance or Medicaid/Medicare. If the patient is indigent the county pays for the transport. Collier County can utilize the design and experience of these non-emergency plans in design of our non-emergency transport plan. A Non-Emergency Transportation plan also frees up law enforcement to provide service and safety to our community. Goal: Whenever possible, the transportation of an individual under the Baker Act or the Marchman Act from a medical facility to receiving facility will be completed by a non - emergency transportation provider. Objectives: • Implement a transportation plan that utilizes non-emergency transportation companies (Ambitrans, MediCab, David Lawrence Center approved staff, or hospital-approved transportation) to transfer individuals being evaluated to treated under the Baker Act or Marchman Act from a medical facility to a receiving facility. • Establish safety provisions that include appropriate medical equipment or safety equipment to meet client needs Formatted: Line spacing: Multiple 1.15 li 11.3.b Packet Pg. 470 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 21 • Establish appropriate level of supervision to ensure safety and prevent elopement Outcome/Impacts: • Provide a dignified, humane, and streamlined method of transportation to and from acute care facilities. • Patient satisfaction with quality of care between receiving facilities • Enhance the ability to fully utilize the capacity of acute care services in the county and reduces the unnecessary delay of transfers between facilities. • Reduce the time that law enforcement is diverted from its primary duties to transport a person being evaluated or treated under the Baker Act or Marchman Act between receiving facilities and local hospitals. • Law enforcement and Collier County EMS will continue to transport Emergency Baker Act or Marchman Act individuals to the appropriate receiving facility • Enhanced continuity and care coordination among providers Data elements required to assess outcome and impact: • Collier County Sheriff's Office non-emergency Baker Act and Marchman Act transport calls for service to David Lawrence Center • Collier County Transportation Plan 2017-2020/Suncoast Region Substance Abuse and Mental Health MOU Workgroup: Lt. Leslie Weidenhammer (? Scott Burgess, Susan Kimper ?) Formatted: Not Highlight 11.3.b Packet Pg. 471 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 22 Priority #6 Improve Community Prevention, and Advocacy, and Education Related to Mental Health and Substance Use Disorders Priority Statement: Overview: Preventing mental health and/or substance use disorders and related problems is critical to behavioral and physical health. Prevention and early intervention strategies can reduce the extent and impact of mental and substance use disorders in Collier County. Prevention approaches focus on helping people develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors. Substance use and mental disorders can make daily activities difficult and impair a person’s ability to work, interact with family, and fulfill other major life functio ns. Mental illness and substance use disorders are among the top conditions that cause disability in the United States. In addition, drug and alcohol use can lead to other chronic diseases including diabetes and heart disease. In 2017 11.2 million Americans 18 years or older had a serious mental illness and 19.7 million people reported having a substance use disorder in the past year. Many individuals experiencing a diagnosable mental health or substance use disorder do not know they have one and do not seek help. For almost all mental disorders, people delay getting help, the median delay is 10 years, and of those who have been diagnosed with a mental illness, only 41 percent of persons use mental health services in a given year. Collaborative and coordinated community efforts to provide awareness, education, prevention and advocacy are critical to reducing the stigma associated with and the myths surrounding mental illness and substance use disorders. A greater understanding of mental illness and substance use interventions can offer the community invaluable information on availability and access to resources and better ways methods to support those who may be experiencing these challenges. Implementation and supportive delivery of evidence based educational opportunities will allow individuals, community and family members and businesses to better identify when someone may be experiencing mental health and substance abuse issues and seek help sooner. Targeted public service information and resources around mental illness and substance abuse will further contribute to stigma reduction and expand awareness of educational opportunities offered in the community. Formatted: Space After: 10 pt, Line spacing: Multiple 1.15 li 11.3.b Packet Pg. 472 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 23 Goal: Provide evidence basedevidence-based education and training on mental health and substance use disorders to the community at large. Objectives: • Create an ongoing educational program that would certify community businesses and organizations to increase knowledge and public awareness • Make available ongoing education to 100% of the Collier population to increase access and reduce stigma relation related to mental health and substance use disorders • Expand Mental Health First Training in the community Outcomes/Impact: • Develop prevention and education activities with Blue Zones or similar concept • Increase knowledge and awareness of mental illness and substance use disorders • Increase awareness and access to resources and services • Increased awareness and education can also increase availability of funding for programs (private donor, grants, etc) • Reduced rates of substance abuse and suicide in Collier; Increased percentage of those experiencing symptoms of mental illness and/or substance abuse enrolling in healthcare services. Data elements required to assess outcome and impact: • Number of participating or certified agencies in Collier County • Number of educational programs provided • Number of attendees • Assess how the training was implemented 11.3.b Packet Pg. 473 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 24 Special Consideration #1 Improve Services to Veterans Experiencing Mental Health and/or Substance Use Disorders Overview: Veterans make up 13% (28,000) of our population in Collier County and an estimated 2,500 are Post Gulf War Veterans. As a country, and community, we have a responsibility to help these Veterans and their families, who from time to time are in need of an array of programs and services that cannot be totally provided by the Department of Veterans Affairs.Veterans Administration. Veterans receive the best care when local communities work collaboratively with the VA to provide a variety of supportive services. . Within this population the most significant issues are Post Traumatic Stress Disorder, Traumatic Brain Injury, military sexual trauma, and and Veteran suicide. Nationally twenty (20) Veterans a day commit suicide, which is twice the rate of the non-veteran population. In addition it is estimated that over 40% of Veterans are returning home with PTSD & TBI. The primary reason is due to multiple tours of duty which are unique to this generation of warriors, and the exposure to “Blast” trauma to the body. These invisible wounds of war present create unique health and transitional issues for Veterans, that result in mental health and substance abuse issues. The impact can be devastating for the Veterans and their families. There is a need in our community to design and implement services and programs to meet the unique needs of our Veteran population. Goal: Make the public and the veteran community aware of the transitional, mental health, housing, and employment needs of post-combat veterans and mobilize resources to address these issues for veterans and their families. Objectives: • Reduce veteran suicides – ensure that trackable data exists for Collier County • Reduce veteran substance abuse – 274-500 Collier vets were treated by the VA in 2018 • Reduce the number of veterans arrested in Collier County, currently approximately 100 per year. • Continue to keep accurate data on veterans who are homeless to advocate for HUD-VASH vouchers 11.3.b Packet Pg. 474 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 25 • Increase the number of arrested veterans who are diverted to veteran treatment court. • Reduce the number of homeless veterans. A count conducted in July 2019 identified 40 homeless veterans living in Collier County. • Include a social worker in the staffing of the Central Receiving Systemervices to interact with and ensure that Veterans are linked with specialized services to meet their unique needs. • Employ a full time social worker or other liaison as part of the Collier County Veterans’ Service Office responsible for coordination of mental health public education, outreach to veterans and families, coordination with services at Bay Pines, VA, Hunger and Homeless Coalition, Home Base and other service providers. • Increase access to combat related unique treatment – prolonged vs multiple therapies. • Educate and advocate on behalf of Veterans regarding size and demographics of this group in our region. • Make veterans and their families aware of and engaged in the programs and services. Data elements required to assess outcome and impact: • Number of homeless veterans; number offered housing • Number of veterans arrested annually; • Number of veterans enrolled in treatment; • Veteran treatment outcomes Workgroup: Dr. Thomas Lansen, Dale Mullin 11.3.b Packet Pg. 475 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 26 Special Consideration #2 Increased Use of Evidence-based and Informed Approaches in all Mental Health and Substance Use Disorder Related Programs and Services Priority Statement: Increase use of evidence based and informed approaches in all programs and services for persons with mental health and substance use disorders. Overview: Evidence-based practice (EBP) began as a movement when the concept was formally introduced in medicine in 1992. This represents an attempt to systematically address the research–to-practice gap that exists in areas of clinical practice, operations and policy-setting, leading to the adoption of more rigorous, proven and effective methods. Since then, the methodology underlying EBP has been applied to various allied health disciplines, along with spreading to other fields such as management, education and law. When this occurs, the evidenced -base/informed approaches implemented are often referred to as “best practices” in any given application or field. At its most basic level, EBP bases systematic decision-making-in operations and clinical practice-on existing science to reduce variation, improve outcomes and reduce cost. Moreover, wherever possible, it also takes into consideration critical population parameters, extant values, preferences, and available resources, along with environmental and organizational contexts relevant to EBP implementation. A distinction is often drawn between “evidenced- based” practices, where the benefits of a process or treatment are delivered under highly controlled conditions, versus “evidenced- informed”, which describes the modification of EBP to be used under less ideal circumstances. The latter represents the modal use of EBP practices and is regarded as a sensible place to start when such ideal circumstances do not exist. The Transdisciplinary EBP model (Satterfield et al., 2009) depicted below illustrates an optimal process where decision-making (and clinical practice) takes all of these variables in to account, against the backdrop of the best available research evidence, to deliver context-relevant, “best practices”. 11.3.b Packet Pg. 476 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 27 Goal: Whenever possible, implement evidence based or informed practices and services to enhance quality and cost effectiveness for targeted mental health and/or substance use disorders programs and services. Outcomes/impact: Patient-centered metrics • Decreased symptoms per targeted disorder (e.g., anxiety, SUD, trauma) leading to improved global functioning. • Increased # of days of work for pay. • Lower arrest/incarceration rates • Decreased number and severity of medical co-morbidities (Congestive Heart Failure, Diabetes); • Decreased number and severity of negative social determinants of health (housing, income, safety, education, access to health services) • Increased patient satisfaction Outcomes/impacts: Operational Metrics • Increased training opportunities negotiated and initiated. • Increased number of staff trained in evidence based treatment/practices. • Ensure that evidenced-based tool kits are implemented as part of an ongoing training program (”More than training”) 11.3.b Packet Pg. 477 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 28 • Increased number and percentage of clients (CLARIFY Patient/Client/Consumer?)patients referred to evidence based treatment as opposed to treatment as usual. • Higher treatment adherence and completion rates of clientspatients in evidence based treatment as opposed to treatment as usual. • Lower “no show” rates in evidence based treatment as opposed to treatment as usual. • Increased number of clientspatients screened for various mental health/substance use disorder problems. • Decreased admission/readmission rates pre/post implementation of evidence based practices. • Reduced number of ED visits pre/post; length of stay in outpatient treatment; medication compliance. • Increased number of case management contacts with peer specialists and care managers. Data elements required to assess outcome & impact: • Medical chart review • Number of arrests/jail days using court records • Work productivity/absenteeism – self report. • SDOH registry – case manager • ClientPatient satisfaction survey • Internal provider agencies logs surveying all operational metrics. Workgroup: Dr. Paul Simeone, Nancy Dauphinais Formatted: Not Highlight 11.3.b Packet Pg. 478 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 29 11.3.b Packet Pg. 479 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc 30 Priority: _____Central Receiving Services_____ Logic Model Goal: Ensure that there is a coordinated system and adequate capacity to assure that citizens in crisis will be able to acce ss emergency mental health and substance use disorder services over the next 20 years. Inputs Required (Resources) Outputs Outcomes -- Impact Activities Participation Short- 1 year Long 2-5 year $25 Million for construction and related capital purchases for Central Receiving Services structure(s) $2-3 Million annual state and local government appropriation for Central Receiving Services operations Define terms and processes regarding ownership, design, construction and funding of Central Receiving Facility/Services/System …For Discussion and consistency Services structure(s) and Furnishings, Fixtures and Equipment. Multiple activities related to design and construction of Central Receiving Services structure(s) and identification and procurement of FFE. Develop an operational budget and plan for sustainable funding for operations. Collier County BOCC and David Lawrence Center David Lawrence Center Collier BOCC, Collier Legislative delegation, David Lawrence Center. Completion of all pre- construction activities and initiation of construction. Submit a Legislative Budget Request to partially fund operations. Secure funding from Collier County to use as match to support Legislative Budget Request. Completion of Construction. Increased inpatient capacity over baseline. Central Receiving Services utilized as single point of access for persons in crisis as a result of a Mental Health and/or Substance Use Disorder Secure state funding and matching county funds to sustain Central Receiving Services operations in perpetuity. 11.3.b Packet Pg. 480 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 31 Priority: _____Housing and Supports________________ Logic Model Goal: Increase availability and accessibility of a variety of housing options for persons with mental hea lth and substance use disorders. Homelessness among persons with mental health and substance use disorders is rare, brief and one-time. Inputs Required (Resources) Outputs Outcomes -- Impact Activities Participation Short- 1 year Long 2-5 year 11.3.b Packet Pg. 481 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 32 Ch 420 F.S. re 10% set aside for special pops % of set aside to SAMH Incentives: Landlords, builders, developers Non-profit developer Affordable Housing units Rental Vouchers Individual’s income Govt Funding (HUD) Private Foundations Benevolent Landlords Supportive Services (Peer Specialists, Case Management, FACT) SOAR providers/volunteers Bridge Housing provider(s) Peer Respite provider(s) Collaboration structure and process/MOU Data Collaborative $$ to execute plan Legislative Advocacy Community Education Advocacy Workforce Training EBP: SH, SE, SOAR Change prejudicial local zoning language  SOAR applications # Supported Employment providers and # hours #Supported Housing providers and # hours Peer (CRPS) supports Implement Peer Run Respite Home Implement Bridge (< 3 mo. emergency housing) Grant Applications: Federal, State, Local, public and private Tracking / reporting entry into housing and services programs Homeless COC State SAMH, Housing HUD County Housing and Community Services Board of County Commissioners State/Fed Legislators Collier SAMH and Housing agencies Landlords Developers / Builders Employment agencies: Goodwill, Vocl Rehab Peers/CRPS Law Enforcement/Jails Judicial / Courts Community members Individuals/Families/Fri ends Media Advocates County Approves % set aside specific to SAMH Discrimination / prejudicial language in local zoning docs # SMI on SSI/SSDI; Medicaid/Medicare MOU and Steering Committee formed/active # Community education sessions, op eds, news articles Identify new non-profit developer  # CRPS  # Providers and volunteers trained in SE, SH, SOAR.  # SOAR applications # days to enroll in programs # days to obtain Transitional housing from jail, hospital or homelessness. # days to obtain permanent housing # employed # homeless SMI 0 Wait lists for housing and services 0 New homeless in CoC PIT count  Days in Community/ Housed (not hospital, jail, shelter)  Days worked for pay  # on SSI/SSDI # Homeless SAMH Accessing emergency/Bridge housing # days in Bridge housing = < 180 # Days Housing and Services Retention/LOS 11.3.b Packet Pg. 482 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 33 Priority: _____Data Collaborative______ Logic Model Goal: Create a data collaborative that will collect and analyze data from all stakeholders that provide services to persons experiencing a mental health and/or substance use disorder and use that information to continuous improve program quality and patient outcom es. Inputs Required (Resources) Outputs Outcomes -- Impact Activities – What we will do Participation Short- 1 year Long 2-5 year Assignment of county staff to provide leadership and direction to development of the data collaborative. Identify and secure participation of essential governmental, non- profit and for profit organizations to participate in and share data with the collaborative Identify and recruit data collaborative members Define data elements to be collected and shared by collaborative members Define standard reports, reporting frequency, and mechanism of report distribution. Data collaborative members utilize shared data to identify and report on emerging issues related to program quality and patient outcomes. Data collaborative members utilize shared data to provide data for grant opportunities and new programming Active participation by 75% or more of recruited members. 100% of data elements and collected and shared by collaborative members. 100% of Standard reports are prepared and distributed on time. Analysis of data to identify trends and emerging issues is reviewed and reported by data collaborative members at least annually. Data collected and reported by data collaborative is used 4 or more times annually in materials prepared in response to funding opportunities or to justify new or revised programming. Data Collaborative is organized, meeting, collecting data and issues a baseline report on data collected. Data Collaborative releases data according to a schedule agreed upon by all members. Data Collaborative identifies at least one emerging issue annually. Data Collaborative provides data that assists in obtaining new funding or reinvestment of existing funding to address emerging community needs in mental health and substance use disorder treatment. 11.3.b Packet Pg. 483 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 34 Priority: _____Justice System Response________________ Logic Model Goal: Expedite deflection and diversion of persons with mental health and/or substance use disorders prior to arrest and from jail to treatment, thereby reducing recidivism, improving community safety and directing resources to optimize outcomes. Inputs Required (Resources) Outputs Outcomes -- Impact Activities Participation Short- 1 year Long 2-5 year Pre-Arrest Diversion Educate Law Enforcement Expand Mental Health Unit Increase capacity of treatment providers Jail Diversion Implement Medication Assisted Treatment at Collier County Jail. Expand Project Recovery Increased number of community based and in jail mental health and substance use counselors Develop alternative in-jail treatment program for inmates already receiving Medication Assisted Treatment prior to incarceration. Expand court ordered assisted outpatient treatment to circuit court. Utilize Mental Health Unit to train road deputies in deflection processes. Seek CJMHSA Reinvestment Grant funding to implement Medication Assisted Treatment in the County Jail. Seek County, State and Federal funding to support additional judicial and treatment team positions for court based diversionary programs including drug court, veteran’s court and assisted outpatient treatment. Mental Health Unit, Collier Sheriff’s Deputies, David Lawrence Center staff Criminal Justice Planning Council Collier Legislative delegation, Collier County government, U.S. Department of Justice, U.S. Department of Health and Human Services, private foundations. # of law enforcement trainings provided. Decrease in arrests for drug possession. Increase in number of referrals to treatment directly from law enforcement. Increase in the number of treatment referrals either in custody or through transfer to community based programs. Decrease in jail days for inmates whose crimes are directly related to their mental health and substance use disorders. Decrease in recidivism among inmates who participate in jail diversion programs. Continued decrease in possession arrests and continued increase in number of referrals to treatment year over year. Quicker response team in diverting from jail or enrolling in jail based programs. Year over year decreases in recidivism among inmates who participate in jail diversion programs. Year over year Increases in the number of treatment referrals either in custody or through transfer to community based programs. 11.3.b Packet Pg. 484 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 35 Priority: ____Non-Emergency Baker Act/Marchman Act Transportation___ Logic Model Goal: Whenever possible, the transportation of an individual under the Baker Act or the Marchman Act from a medical facility to receiving facility will be completed by a non-emergency transportation provider. Inputs Required (Resources) Outputs Outcomes -- Impact Activities Participation Short- 1 year Long 2-5 year Transportation Workgroup consisting of involved partners – CCSO, Collier County Government, David Lawrence Center, NCH, XXX, XXX, XXX Funding to support transportation plan and costs of transport vehicles and drivers. Develop answers to the who, what, when and where questions that will drive the structure of the transportation agreement. Prepare a cost analysis that includes current costs for all partners, the annual number of transports provided, the annual number of patients transported and a projection of future need. Develop a share cost agreement among partners to be either included in the Transportation Plan or included by reference in the plan Transportation Workgroup Transportation Workgroup Transportation Plan written and signed off by all partners. Identification of Transportation Provider or Providers Cost sharing agreement developed and signed off by all partners. Law enforcement agencies no longer providing non- emergency transport except in cases of unstable individuals at high risk to harm self or others. Increased patient satisfaction regarding quality of care in transportation. Law enforcement agencies re-allocate time previously spent in transportation to other public safety activities. Transportation Contract (s) in force and functioning. Transportation Workgroup continues to meet to review data and address any inter- agency issues that may develop. 11.3.b Packet Pg. 485 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 36 Priority: _____Prevention________________ Logic Model Goal: Provide evidence based education and training on mental health and substance use disorders to the community at large. Inputs Required (Resources) Outputs Outcomes -- Impact Activities Participation Short- 1 year Long 2-5 year Identify collaborative agencies and personnel that provide evidence based prevention programs. Identify evidence based programs available. Participation in Task Force for App development (mh/substance use inclusion PSA – Awareness avenues – identify social media print materials. Chamber of Commerce Develop Collaborative Partners in Prevention Develop speaker’s bureau Assist in local prevention App development Development or identification of plan and materials Develop resource center that can provide materials and programs to the community. Drug Free Collier NAMI Mental health providers Collaborative group of providers for education Participation Task Force provides training for agencies and community responders Identify funding Linkage with print and electronic media Funding and staffing to support education and prevention Relationship to 211. App implementation increased access to recovery services Awareness Prevention/Education campaigns 11.3.b Packet Pg. 486 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 37 Placeholder for Veterans Logic Model 11.3.b Packet Pg. 487 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 38 Priority: _____Evidence Based Practice________________ Logic Model Goal: Whenever possible, implement evidence based or informed practices and services to enhance quality and cost effectiveness for targeted mental health and/or substance use disorders Inputs Required (Resources) Outputs Outcomes -- Impact Activities Participation Short- 1 year Long 2-5 year 11.3.b Packet Pg. 488 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 39 Trauma Informed Care Funding for training Qualified trainers Engaged and committed staff and provider agencies Assertive Community Treatment Increased state funding to support Collier County’s 100 person team. Funding for a second team for early intervention Medication Assisted Treatment Funding for Medication and Services through CJMHSA Reinvestment Grant Qualified workforce Legislative Budget Request to increase funding levels for all Florida FACT Teams Fidelity to ACT program model Seek funding through Reinvestment Grant funding in 2020. # of credentialed trainers and practitioners # of trained staff # of clients referred to trauma informed care # of participants/completers Collier Legislative Delegation, Florida Department of Children and Families David Lawrence Center Criminal Justice Planning Council Increased rates of treatment retention and completion. Reduced ED visits, treatment readmission rates, and length of stay. Increased medication adherence and access to and utilization of case management services. Increased levels of functioning as measured by standardized assessments and performance measures. Reduced incarceration and inpatient admissions. Improved global assessment of functioning. Medication adherence Reduced ED visits and overdoses. Reduced admissions to inpatient treatment. Decreased symptoms and improved global assessment of functioning. Priority: _____ Evidence Based Practice (cont)_______________ Logic Model Goal: Whenever possible, implement evidence based or informed practices and services to enhance quality and cost effectivene ss for targeted mental health and/or substance use disorders Inputs Required Outputs Outcomes -- Impact 11.3.b Packet Pg. 489 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County 40 (Resources) Activities Participation Short- 1 year Long 2-5 year Supportive Employment Trainers/Training in Supportive Employment practices from Pathways to Work and Goodwill Industries. Peer Services Engaged peers able and willing to be employed as certified peer specialists. Support peers in navigating background clearance barriers. Steady funding to enable agencies to employ peer specialists. Diversion/Deflection Mental Health Intervention Team Mobile Crisis Response Team Crisis Intervention Training Licensed Professionals for Assessment and Referral Case Managers and Peers Training activities negotiated and presented according to a an annual training schedule Peer specialist recruitment. Advocacy provided to assist peers who encounter difficulty obtaining background clearance due to criminal history or other barriers. Pathways to Work, Goodwill Industries. Increased number of trained supportive employment specialists Increased number of participants receiving supportive employment services. Provider agencies Provider agencies Review, reinvestment of current state, federal and local dollars to provide mental health and substance use disorder treatment # of individuals diverted # of follow up contacts with at-risk individuals Training activities negotiated and initiated Increased number of certified peer specialists. Increased number of client contacts with certified peer specialists. Increased number of days worked for pay among those participants who treatment plans include supportive employment services. Increased treatment adherence, retention in treatment and completion rates among those participants supported by a peer specialist. Decreased treatment readmission rates for those participants supported by a peer specialist. Reduced frequency of opioid overdose, ED visits and admissions to inpatient. Reduced drug related crime Decreased symptomatology and improved global assessment of functioning. Increase in # of days worked for pay. 11.3.b Packet Pg. 490 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Health and Addiction Ad Hoc Committee Meeting (as of September 2019) Committee Membership Filled Positions Membership Credential Committee Member Organization 1 Veterans Service Organization Dale Mullin Wounded Warriors of Collier 2 Collier County Sheriff’s Office Lt. Leslie Weidenhammer CCSO 3 Licensed Psychiatrist/Psychologist Dr. Paul Simeone Lee Health 4 Licensed Behavioral Health Prof. Susan Kimper NCH 5 Medical Health Professional Dr. Thomas Lansen 6 David Lawrence Center Scott Burgess DLC 7 NAMI Dr. Pam Baker NAMI 8 At-large Honorable Janeice Martin 20th Judicial Circuit 9 Collier County Grantor Agency Robert Saunders 10 Homeless Advocacy Organization Michael Overbay Hunger & Homeless Coalition 11 Peer Specialist CM Michelle McLeod City of Naples 12 Recovery Community Janice Rosen 13 At-large Dr. Michael D’Amico 14 At-large Caroline Brennan Collier County Public Schools 15 At-large Russell Budd PBS Contractors 16 At-large Pat Barton 17 At-large Dr. Jerry Godshaw 18 At-large Trista Meister Mindful Marketing Vacant Positions Membership Credential Committee Member Organization At-large (1) Vacant Item 8.2 - Existing Committees and Future Recommendations 11.3.b Packet Pg. 491 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc COLLIER COUNTY PUBLIC SAFETY COORDINATING COUNCIL ROSTER OF MEMBERS (As of July 2019) Membership Type Name Title 1. Statutory Member Commissioner Burt Saunders Commissioner, Board of County Commissioners and PSCC Chairman 2. Statutory Member Sheriff Kevin Rambosk Sheriff, Chief Correctional Officer Sheriff ‘s designee if unable to attend Chief Chris Roberts Sheriff’s Office – Jail Administrator 3. Statutory Member Chief Judge Michael T. McHugh Chief Circuit Judge 4. Statutory Member Judge Rob Crown County Court Judge 5. Statutory Member Amira Fox State Attorney, 20th Judicial Circuit State Attorney’s designee if unable to attend Nicole Mirra State Attorney’s Office-Collier County 6. Statutory Member Kathy A. Smith Public Defender, 20th Judicial Circuit Public Defender’s designee if unable to attend Rex Darrow Supervising Assistant Public Defender 7. Statutory Member Terri McCall State Prob. Circuit Administrator State Probation Administrator’s designee if unable to attend Robin Kelly Senior Supervisor State Probation 8. Statutory Member Jeff Nichols Director of County Probation County Probation Director’s designee if unable to attend Juan Ramos Collier Probation 9. Statutory Member Scott Burgess Executive Director, David Lawrence Center DLC Executive Director’s designee if unable to attend Nancy Dauphinais David Lawrence Center, Chief Operating Officer 10. Statutory Member Joe Paterno Executive Director-Southwest Florida Workforce Dev. Non-voting participant Crystal K. Kinzel Clerk of the Circuit Court & Comptroller for Collier County. Non-voting participant Mike Sheffield Director, Collier Communications Non-voting participant Katina Bouza Director, Corrections Support Division- CCSO Non-voting participant Judge Janeice Martin County Court Judge 11.3.b Packet Pg. 492 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc Criminal Justice Mental Health Substance Abuse (CJMHSA) Planning Council Member Organization Eric Townsend Public Defender’s Office Amanda Krause State Attorney’s Office Beverly Belli David Lawrence Center Bianca Borges David Lawrence Center Cindy Highsmith National Alliance on Mental Illness Chief Chris Roberts Collier County Sheriff’s Office Connie Kelley Public Defenders’ Office Dawn Whelen Community & Human Services (County) Tami Bailey Community & Human Services (County) Michael Overway Hunger & Homeless Coalition Heather Davis Veteran Justice Outreach Program Jennifer Campo Collier County Sheriff’s Office Julie Franklin Shelter for Abused Women and Children The Honorable Janiece Martin 20th Judicial Circuit Jeff Nichols County Probation Juan Ramos County Probation Katie Burrows David Lawrence Center Katina Bouza Collier County Sheriff’s Office Kerri Miller David Lawrence Center Sheriff Kevin Rambosk Kristi Sonntag Community & Human Services (County) Lt. Leslie Weidenhammer Collier County Sheriff’s Office Laura Ferrell State Attorney’s Office Lois Bollin SWFL Vets Alliance Marien Ruiz Collier County Sheriff’s Office Mark Englehardt USF Michael Lisboa CCSO Michael Sheffield Collier County Administration Robin Eckenroth CCSO Monique Nagy CCSO Nancy Dauphinis David Lawrence Center Nicole Mira State Attorney’s Office Pam Baker NAMI Peter Arvin State Probation Darrow Rexford Public Defender’s Office Scott Burgess David Lawrence Center Susan Vivonetto CCSO Tyrone Davis Naples Police Department Traci Foss Dept. of Juvenile Justice Barbaro Baez-Alvarez NAMI Dareece Canady CCSO Michelle Rubbo Community & Human Services (County) Kylie Sumner CPE 11.3.b Packet Pg. 493 Attachment: [Linked] Agenda and Back-up Document Packet - October 08, 2019 (11025 : Collier County Mental Illness and Addiction Ad Hoc